Tick-Borne Diseases Sharply on the Rise (Nantucket Inquirer & Mirror 9/5)

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Tick-borne diseases sharply on the rise

By Graziadei

I & M Senior Writer

The number of patients diagnosed with tick-borne diseases on Nantucket has

risen sharply this year to 338 confirmed cases, already well above last

year’

s total, with tick season still in full swing and more positive test results

sure to come.

Nantucket Cottage Hospital’s infection-control nurse Charlene Chadwick

reported 262 confirmed cases of Lyme disease, 59 positive tests for babesiosis,

and 17 cases of ehrlichiosis so far in 2008, all record highs for the island.

Those figures far exceed what were already staggeringly high numbers of

confirmed cases in 2007, when Chadwick recorded 189 positive tests for Lyme

disease, 53 cases of babesiosis and 15 cases of ehrlichiosis.

Tick-borne diseases, the result of bites by deer ticks and dog ticks, can

cause significant joint, heart and central nervous system problems if they are

not diagnosed early and treated appropriately, according to the state

Department of Public Health.

Nantucket and Martha’s Vineyard, with large deer populations, typically have

a high number of tick-borne diseases, and per capita, rank among the

highest incidence rates in the world.

Nantucket surgeon Dr. Tim Lepore, one of the foremost experts in the field

of tick-borne diseases, said he was not surprised at the growing number of

cases reported on Nantucket because island doctors have become more aware of

the problem and are better able to diagnose the diseases. In fact, Lepore said,

there are probably even more cases that go undocumented, possibly twice as

many as are diagnosed.

“Are those numbers high? Certainly they’re higher, but there’s so many

factors,†Lepore said. “I’m not shocked by that number of cases. I

suspect at

least twice as many are going undiagnosed because people leave the island. If

I could be king for a day and grab everyone coming on and off the island, I

could pick up probably twice that number, because people go off to Mount St.

Elsewhere and I get calls from across the country and they never enter into

our numbers.â€

As he has preached in the past, Lepore emphasized that the only way to

reduce the incidence of tick-borne diseases is to reduce the number of their

hosts: the island’s deer population. Lepore, an avid hunter himself, said it

is

the most effective way to bring the diseases under control.

State fish and wildlife officials have estimated that there are between

1,600 and 2,400 deer on the island, about 45 to 55 per square mile, far more

than is considered safe by public health standards.

“Controlling the deer herd is the way to control these diseases,†Lepore

said. “If you cut down the deer herd, you’ll cut down the deer ticks. That

is

the solution to this problem. The key thing also is to check yourself for

ticks. (The diseases) are all treatable and curable but you have to be

aggressive in looking for it and treating it. On Nantucket, you have to think

about

it.â€

In 2005, the town attempted to cull the deer herd with an extra week of

hunting in February, over and above the normal two-week season in late November

and early December. The special hunt, sanctioned by the state Division of

Fisheries and Wildlife, was open to all, and was the only deer hunting allowed

throughout Massachusetts in February, so hundreds of hunters from across the

country descended on Nantucket. While 246 deer were ultimately killed, the

inaugural February hunt ended in controversy as island residents bombarded the

Board of Selectmen with complaints, prompting the board to eventually reverse

course and declare the special season a mistake. Numerous residents grumbled

about hunters on private property, on public roads, and other inappropriate

behavior, while others questioned the science behind the hunt, and said there

was little or no evidence showing that a reduction in the deer herd would

result in fewer cases of tick-borne diseases.

The Selectmen petitioned the Division of Fisheries and Wildlife to end the

hunt, and in December 2005, following a public hearing, its board voted 6-1

to cancel the special season.

Tufts University associate professor of infectious diseases Sam Telford, who

has been studying tick diseases on Nantucket since 1985, said the island’s

spring weather may have played a role in the increased number of cases

reported by the hospital, and agreed with Lepore that reducing the number of

deer

was the most effective avenue to address the problem.

“The tick is dependent upon humidity, and I’ve seen in the past if you have

a cool and damp May and June, you get more babesiosis and ehrlichiosis,â€

Telford said. “Nantucket still ranks in the top five counties in the U.S.

every

year. So it’s clear there’s a problem. It’s been three years since the

big

deer hunt, so it could be the deer population is rebounding and the ticks are

reproducing more. There’s no question that reducing the deer will reduce

deer ticks.

“I was extremely disappointed with what Nantucket did (in canceling the

February hunt) after all the hard work we did,†Telford continued. “I think

the

town may have burned its bridges, because Mass Wildlife is not going to

consider it again unless there’s some assurance the town will stick to its

guns

and stand up to the activist population and say ‘this is for the general good

for the long term.’ We’ve lost three years.â€

Other scientists, however, have come to different conclusions about the

effectiveness of extended deer hunting on local tick populations. Oktay,

of

the UMass Boston Field Station in Quaise, said she was not convinced there

is a correlation between reducing the deer population and the prevalence of

tick-borne diseases.

“I think an increased hunting season is not going to do it. You need to use

a combination of approaches and I'd like to see either birth-control methods

used along with occasional sharpshooters . . . Other islands have actually

seen an increase in ticks after the reduction of deer populations. Ticks can

find other large hosts besides deer if they need to,†she said, citing a Penn

State University study.

Island resident Carol Black, one of the most outspoken opponents of the

February deer hunt in 2005, said she was disappointed the town had not

embarked

on a more expansive public education campaign about the danger of tick-borne

diseases and how residents can avoid them. Black said she would be just as

opposed to an extended hunt now as she was in 2005.

“The deer don’t carry Lyme disease,†Black said. “We need to target the

ticks. And people need to take responsibility for checking for ticks, putting

out products like Daminex on their yards, and treating their clothing.â€

Black also cited a recent article in the Boston Globe about University of

Rhode Island professor of entomology and tick expert Tom Mather, who claims

white-footed mice are more problematic hosts of ticks than deer.

Yet the growing number of cases of tick-borne diseases has alarmed Nantucket’

s seasonal residents, who voiced their concern to the Selectmen during a

recent forum sponsored by the Nantucket Community Association and the Advisory

Board of Non-Voting Taxpayers.

“A huge percentage of our population has had Lyme disease or babesiosis or

both,†said Tom Nevers seasonal resident Jack Warner. “Renters are getting

spooked, and the worry is that if word spreads in the national press that we’

re the epicenter of tick-borne diseases, that would be devastating for

rental-property owners.

“All we’re asking is that you include it on your agenda because it deserves

being dealt with at your level,†Warner said to loud applause from the rest

of the audience.

While the Selectmen attempted to explain the community outrage over the

special February deer hunt, Warner and others in attendance questioned why they

had not tried other measures, such as an oral contraceptive like those used in

Canada.

Health Department director Ray said he and the Board of Health would

discuss the rising number of cases of tick-borne diseases this month, and

the board would likely consider the prospect of implementing the special hunt

again, along with other measures.

“If this is brought to the board, and it wishes to, it’s got to look at an

extended hunt and the potential for sterilizing deer,†Ray said. “I’m

going

to be coming to the board with a lot of discussion topics. We need to open

up some of these areas that are posted to hunting. As ridiculous as it sounds,

deer know where the safe areas are. They have a sense and they know when the

season starts. We can go as crazy as getting ahold of the U.S. government

and bringing in some of the Marine and Army snipers in training.â€

Ray added that he believed the increase in documented tick-borne diseases on

Nantucket was attributable to a number of factors.

“First of all is the fact that the deer’s habitat has been squeezed down to

an extremely small area and the herd is incapable of finding enough food

out there because their old feeding areas have been built upon,†Ray said.

“

They are encroaching on residential properties, and people are seeing more and

more deer in their back yards, feeding on gardens and their lawns. As they

move into the public sector, they’re dropping and leaving the ticks in places

where humans are more likely to be.â€

Coughlan

President

MA Lyme & Tick-Borne Disease Awareness Assoc.

Mashpee, MA

(508) 564-7445

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